Pregnancy and Pot: What to Know About the American Academy of Pediatrics' First-Ever Official Guidelines

If you’ve got a horrible case of all-day nausea during pregnancy or need a well-deserved break from the pressures of being a new breastfeeding mom, a puff of marijuana might seem like an ideal solution. And it’s one that’s being adopted by more moms than ever, according to a new report by the American Academy of Pediatrics (AAP), as more states legalize the drug while moms and even some doulas and midwives tout its efficacy on social media. But marijuana during pregnancy and breastfeeding, the group says, is likely not as safe as many parents assume it is. That’s why the AAP has released its first-ever set of official guidelines on marijuana use during pregnancy and breastfeeding.

We’ll get into the new guidelines in more detail below. If you’re a mom-to-be or new parent and are wondering what they mean for you, the most important takeaways are that the AAP unequivocally states that women should not use marijuana in any form during pregnancy or if they’re breastfeeding. Moreover, if you've quit using marijuana (or never have), you should continue to abstain during pregnancy or if you're nursing. Here’s why.

How many moms in the U.S. use marijuana during pregnancy and breastfeeding?

As of 2013, an estimated 8.6 percent of pregnant women between the ages of 18 to 25 and 3.2 percent of women ages 26 through 44 used illicit drugs (such as marijuana, cocaine, heroin, hallucinogens and inhalants used for non-medical purposes), according to the National Survey of Drug Use and Health (NSDUH). Other research has put use as high as 28 percent among urban, socioeconomically disadvantaged young women.

Among these drugs, marijuana is the most common — and use is rising, according to the AAP’s new report, “Marijuana Use During Pregnancy and Breastfeeding: Implications for Neonatal and Childhood Outcomes,” published in Pediatrics. Between 2002 and 2014, marijuana use among pregnant women increased 67 percent, from 2.3 percent to 3.84 percent. The NSDUH report found that overall, moms used marijuana the most during the first trimester, at 9 percent, with usage decreasing to 4.8 percent in the second trimester and 2.4 percent in the third. Other research has found that up to 60 percent of women who use marijuana do so throughout their entire pregnancies, believing it’s safer than tobacco.

Stats on marijuana use during breastfeeding are harder to come by, but one study found that as many as 41 percent of moms who smoked pot before becoming pregnant had used pot since their babies were born.

How marijuana affects babies during pregnancy and breastfeeding

Research has shown that THC —the chemical in marijuana that causes psychoactive effects—crosses the placenta and can appear in blood concentrations in baby up to a third of what they are in Mom, where it readily enters the brain of a fetus. THC can also be present in breast milk for up to six days after last use. In other words, when you smoke, your baby is partaking. And the potential risks are greater than ever, since average concentrations of tetrahydrocannabinol have more than quadrupled since the 1980s.

While experts still don’t know what happens once marijuana gets into a baby’s system, the AAP notes that THC has been shown to bind with cannabinoid receptors in the developing brain and may “hijack” normal neuronal growth. Marijuana might also mess with developing babies’ epigenetics—how genes express themselves—including genes responsible for a number of brain systems.

The effects could be long-lasting. In a number of studies, babies whose moms who use marijuana during pregnancies were more likely to have neurodevelopmental issues starting at around 4 to 6 years of age lasting into adolescence, including impairment to executive skills like concentration, attention, impulse control and problem-solving. Some studies have even found that babies who were exposed to marijuana during pregnancy were at higher risk of substance use disorder and mental illness as teens and adults.

What’s more, cannabidiol, a non-psychoactive substance in marijuana, has been shown to reduce the placenta’s effectiveness at blocking other medications or drugs a mom might be taking during pregnancy, which could expose babies to more potentially dangerous chemicals. Compared to women who didn’t use marijuana, the uterine blood flow from mom to baby might also be decreased among marijuana users. Other research has found that heavy marijuana use during pregnancy may result in preterm birth and low birthweight, although findings have been conflicting.

There’s been a whole lot less research done on marijuana use among breastfeeding moms, but there is concern it may impact babies’ brains and affect growth and motor skills in babies—although studies have yet to make the connection.

“Many of these effects may not show up right away, but…children’s and teens’ cognitive ability to manage their time and school work might be harmed down the line from marijuana use during their mother’s pregnancy,” said Sheryl A. Ryan, M.D., a lead author of the report and chair of the AAP Committee on Substance Use and Prevention, in a statement. For this reason, the AAP is calling for more research on how using the drug during pregnancy and breastfeeding might affect babies.

What this means for you

Even though it’s touted as a morning sickness cure, there’s actually little evidence showing that marijuana use during pregnancy actually helps quell nausea. In fact, some research has found that women who use marijuana are even slightly more likely to have nausea.

“The fact that marijuana is legal in many states may give the impression the drug is harmless during pregnancy, especially with stories swirling on social media about using it for nausea with morning sickness,” said Ryan. “But in fact, this is still a big question. We do not have good safety data on prenatal exposure to marijuana. Based on the limited data that does exist, as pediatricians, we believe there is cause to be concerned about how the drug will impact the long-term development of children.”

The AAP also advises that pediatricians who treat sexually active patients, women of reproductive age, or women who are thinking of getting pregnant talk to their patients about the risks of THC and marijuana during pregnancy and the new guidelines in a thorough, non-judgmental way. This is similar to other organizations, including The American College of Obstetricians and Gynecologists (ACOG), which represents American ob-gyns and recommends that doctors should advise against marijuana use during pregnancy, since the benefits and dangers are still not well understood. Given that there are potentially big downsides, why take the risk?

“There’s still a lot we don’t know,” said Mary E. O’Connor, M.D., a co-author of the clinical report and an executive committee member of the AAP Section on Breastfeeding, in a statement. “But, based on what we know now, we’re advising women who are pregnant or nursing that the safest choice for their child is to avoid marijuana.”